In 2015, home health spending could top roughly $86.5 billion, according to the CMS Office of the Actuary, which annually produces projections of health care spending within the National Health Expenditure (NHE) Accounts.

In 2013, the most recent date for which historical NHE data is available, home health expenditures topped approximately $79.8 billion, up 3.4% from the previous year. And the sector is projected to see continued growth each year through 2024, according to the projected NHE numbers.

On average, home health care expenditures are projected to grow by at least 6% each year from 2014 through 2024—a rate that is higher than overall national health care spending.

For 2014-2024, health spending is projected to grow at an average rate of 5.8% per year, rising to $5.4 trillion by 2024, according to the NHE data.

As a result, the health spending share of the U.S. economy is projected to rise from 17.4% in 2013, to 19.6% in 2024.

In the projection period, a number of factors are expected to contribute to faster spending growth, including coverage expansions from the Affordable Care Act, as well as quicker growth in medical care use as a result of the improving U.S. economy and aging population, says a Health Affairs article on the NHE report.

“Ultimately, these longer-lasting factors result in relatively modest projected health spending growth over the next decade, averaging close to 6% per year—compared to the average annual growth of about 9% over the three decades prior to the recession—even during a period when the uninsured population is expected to decline by almost eighteen million,” the article states.

Written by Jason Oliva

The post Home Health Spending to Reach $156 Billion Over Next Decade appeared first on Home Health Care News.

Effective July 29, the moratorium will continue to prohibit for an additional six months the enrollment of new home health agencies and ambulance service providers within certain metro areas of Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey, according to a CMS notice published Tuesday in the Federal Register.

The moratorium, which CMS first imposed in July 2013, zeroes-in on geographic areas that the agency has perceived to be “hot spots” for fraudulent activity. Under its terms, no new provider or supplier applications will be approved for CMS’s Medicare, Medicaid and Children’s Health Insurance Program (CHIP).

Since this temporary ban was instituted two years ago, CMS has extended the moratorium period each year by six-month increments.

Initially, the moratorium barred new home health providers from enrolling in CMS programs only in Chicago and Miami, along with ground ambulance suppliers in Houston. In January 2014, CMS expanded the geographic reach of moratorium to include the cities of Fort Lauderdale, Fla., Detroit, Dallas and the Greater Philadelphia area.

Under the moratorium, new home health providers and ambulance suppliers will be barred from enrolling in CMS programs in the following counties:

• Florida: Broward, Miami-Dade and Monroe counties.
• Illinois: Cook, DuPage, Kane, Lake, McHenry and Will counties.
• Michigan: Macomb, Monroe, Oakland, Washtenaw and Wayne counties.
• Texas: Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller counties.
• Pennsylvania: Bucks, Delaway, Montgomery and Philadelphia counties.
• New Jersey: Burlington, Camden and Gloucester counties.

Written by Jason Oliva

The post CMS Extends Home Health Agency Moratorium in Select Cities appeared first on Home Health Care News.

To overcome obstacles associated with job training, recruitment and retention problems, policymakers must make a “major workforce investment” to ensure that successful care coordination and care management can occur, according to the report “Who’s Going to Care? Analysis and Recommendations for Building New York’s Care Coordination and Care Management Workforce,” released this month by 1199SEIU United Healthcare Workers East and the Primary Care Development Corporation (PCDC).

The report examines the State of New York’s Health Home program, which manage care of Medicaid enrollees with complex and often costly chronic conditions that drive a high volume of inpatient episodes.

By analyzing the Health Homes model, researchers believe this initiative can provide insight on the steps needed to create and support a skilled care coordination and care management workforce for the health care system as a whole.

“New York’s experiment in shifting care for elderly residents from nursing homes to a largely underpaid home care workforce offers painful and expensive lessons as the larger and more complex healthcare system embarks on a similar shift,” states the report’s researchers.

To better understand provider challenges and expectations for the care coordination and care management workforce, 1199SEIU Healthcare Workers East and the Primary Care Development Corporation (PCDC) surveyed New York State Health Home providers about workforce roles and jobs, including education and skills requirements, salary range and training needs.

The survey was sent to 213 Health Homes primarily in the New York City/downstate area. Community-based organizations comprised 65% of survey respondents, while community health centers represented 27% and hospitals accounted for 8%.

Key findings from the survey indicated that recruitment and retention challenges are prevalent and are driven by several factors, including insufficient salaries, high caseload and lack of appropriate skills and competencies.

A significant majority of organizations reported recruitment challenges (88%) and retention challenges (78%), while more than half reported insufficient salaries as a barrier to recruitment and retention.

On average, salaries reported by the organization that were surveyed—the majority of which were community-based—are 27% to 50% lower than the salaries for those with similar titles operating in the hospital workforce.

Responses also revealed that ongoing training and supervision are needed for staff that provide care coordination and care management, as less than 60% of organizations responding said they provide training in patient-centered care and chronic care management.

Furthermore, less than half of organizations said they offer training in health coaching, working in a team, housing placement, stress management or running and reading reports—all skills that organizations considered crucial to care coordination and care management roles.

1199SEIU, whose mission is to achieve quality care and good jobs for all, is the largest health care union in New York, representing over 300,000 members throughout the state. Its members are “deeply committed” to transforming the health care system to better serve communities, said George Gresham, president of 1199SEIU.

“Key to achieving this goal is ensuring that high-quality care coordination services are available to everyone who needs them, which will require thousands of new care managers and other workers,” Gresham said in a written statement. “Policymakers must ensure that the structure is in place to train, recruit and retain this new workforce.”

Based on an analysis of survey results and additional research, 1199SEIU and PCDC developed several recommendations for policymakers and health care organizations.

These include collecting data about the care coordination and care management workforce; requiring all payers to support coordination and care management; ensuring recruitment and retention through sufficient wages and benefits for staff; as well as provide ongoing support for the development of the care coordination and care management workforce.

The workforce lessons learned through Health Homes, and other programs involving high levels of care management, researchers say, will be particularly relevant as New York launches its five-year Delivery System Reform Incentive Payment Program (DSRIP), which has a goal of reducing avoidable hospitalizations by 25% by building community-based health care capacity.

Through DSRIP, over $400 million will be available for workforce development, including training and retaining the health care labor force.

This presents a “remarkable opportunity” for New York State to minimize disruption for the existing healthcare workforce as it transitions to new settings and to provide meaningful careers for low wage, underemployed or unemployed individuals in low income communities, all while improving the quality of care for the highest need patients, according to the report’s researchers.

“This report demonstrates that providers need adequate funding to invest in our care coordination workforce, including compensation, supervision and training, in order for these services to play a transformative role in New York State’s health care system,” said Charles King, president and CEO of Housing Works, which participates in the Health Home initiatives.

Written by Jason Oliva

The post Major Workforce Overhaul Needed for Home Health Care Coordination appeared first on Home Health Care News.

The company announced last week its planned acquisition of Jacksonville, Fla.-based Ingenios Health Co., a provider of tech-enabled in-home and in-facility health risk assessments on behalf of payers such as Medicare Advantage, Managed Medicaid, Commercial Exchange and long-term care. 

With the acquisition, Almost Family gains entry into growing health assessment market as well as the nurse practitioner business, which the company notes is a “useful connecting point” that is integral to health care delivery.

“By using nurse practitioners to conduct comprehensive health assessments in patients’ homes and physician practices, we believe Ingenios will provide a foundational basis for improved care planning and delivery with meaningful cost savings,” said Almost Family Chairman and CEO William Yarmuth in a written statement.

The company plans to develop the Ingenios model in markets where it currently provides home health and Accountable Care Organization services, as well as in new markets where the two companies can develop together, Yarmuth added.

As health care reimbursement models evolve, Almost Family believes these new health assessment capabilities will enable it to provide a key element in the evolution of improved care planning and delivery.

Ingenios was founded on the principle that intelligent prevention is the key to providing “true care coordination and improved patient quality” to reduce the overall medical burden and improve patients’ quality of care, said Ingenios CEO John Shermyen in a prepared statement. 

As a result of the acquisition, Shermyen will lead Almost Family’s Healthcare Innovations segment. 

“We believe the evolution of the U.S. health care delivery system will ultimately require providers to accept financial risk for the clinical and cost outcomes we produce,” Yarmuth said. “We also believe assessment, care planning and innovative technology capabilities are essential as we position ourselves to succeed in that environment.”

Prior to founding Ingenios, Shermyen founded and served as the former CEO of LogistiCare Solutions, an access management company serving 13 million Medicaid and Medicare Advantage members in 43 states. Under his leadership, the company grew revenues of over $460 million primarily from capitated non-emergency medical transportation programs. 

“We expect this transaction along with John’s long-track record of growing and developing innovative businesses such as LogistiCare to be real assets for us as we continue to evolve our business model to address the challenges of the rapidly changing U.S. health care delivery system,” Yarmuth stated. 

Almost Family acquired 100% of the equity of Ingenios for approximately 260,000 shares of common stock plus $2 million in cash. Ingenios is expected to be mildly dilutive to earnings per share this year, and accretive in 2017.

Written by Jason Oliva

The post Almost Family Acquires Health Assessment Company for $2 Million appeared first on Home Health Care News.

Specifically, the agency is proposing to substantially raise the minimum salary level at which “white collar” workers, including those in the home health industry, can be exempt from overtime protections.

Under the proposed rule published in the Federal Register, the DOL would raise the standard salary level required for exemption from its current value of $455 a week ($23,660 for a full-year worker) to $970 per week, or $50,440 for full-year workers.

The Fair Labor Standards Act (FLSA) guarantees a minimum wage and overtime pay at a rate that is no less than 1.5 times the employee’s regular rate for hours worked over 40 in a workweek. 

While these protections extend to most workers, the FLSA provides several exemptions, particularly for executive, administrative and professionals, or “white collar” workers, according to language used in the proposed rule.

Others that are not required to be paid the minimum wage or overtime pay include domestic service workers employed to provide “companionship services” either for the elderly, ill, injured or disabled. These workers include nursing, psychiatric, home health aides, personal and home care aides. 

“All the workers who fall within these occupational and industry categories were previously excluded from the analysis because they are paid on an hourly basis and/or are in an occupation where workers have no likelihood of qualifying for the section 13(a)(I) exemption,” the proposed rule states.

One of the DOL’s primary goals in this proposed rule is updating the section 13(a)(1) exemption’s salary requirements. 

Under current regulations, an executive, administrative or professional employee must be paid at least $455 per week—$23,660 per year for a full-year worker—in order to come within the standard exemption. Additionally, in order to come within the exemption for highly compensated employees, such an employee must earn at least $100,000 in total annual compensation.

For non-salaried home care workers, which are exempt from the proposed policies issued in the rule, the issue of overtime and minimum wage protections has been an ongoing debate across the country.

Massachusetts was the first state to enact a $15 per hour starting minimum wage for home care workers, while caregivers elsewhere continue their own respective fights for $15. 

The DOL will accept submitted written comments on the proposed rule through September 4, 2015. 

View the proposed rule in the Federal Register. 

Written by Jason Oliva

The post DOL Rule Would Expand Overtime for Salaried Home Care Workers appeared first on Home Health Care News.

The definition of “employ” is the key factor when determining whether a worker is an employee or an independent contractor, according to the guidance released last week by the U.S. Department of Labor’s (DOL) Wage and Hour Division. Although the guidance does not create any new requirements, it is meant to remind employers about the classification of their workers.

“The correct classification of workers as employees or independent contractors has critical implications for the legal protections that workers receive, particularly when misclassification occurs in industries employing low wage workers,” states the guidance issued by David Weil, administrator of the DOL’s Wage and Hour Division (WHD).

According to Weil, the WHD receives “numerous complaints” from workers alleging misclassification in this regard.

“Misclassification of employees as independent contractors is found in an increasing number of workplaces in the United States, in part reflecting larger restructuring of business organizations,” Weil stated in the guidance.

Because a worker’s classification determines the benefits and protections they may receive from employers, proper distinction is critical.

For example, when employers improperly classify employees as independent contractors, the employees may not receive important workplace protections such as minimum wage, overtime pay, unemployment insurance and workers’ compensation.

But while independent contracting relationships can be advantageous for workers and businesses, the DOL raises concerns that some employees may be intentionally misclassified as a means to cut costs and avoid compliance with labor laws.

The DOL believes that additional guidance on the standards for determining who is an employee under the Fair Labor Standards Act (FLSA) will help with the proper classification of workers and ultimately curtail misclassifications.

In order to determine if a worker qualifies as an employee or an independent contractor under the FLSA, courts use a multi-factoral “economic realities” test, which focuses on whether the worker is economically dependent on the employer, or is in business for himself/herself.

As part of the guidance, the DOL listed six guiding factors that, when analyzed collectively, determine whether a worker is economically dependent on their employer, thereby classifying him/her as an employee or independent contractor.

The guidance asks employers to examine whether the work being performed is an integral part of the employer’s business; if the worker’s managerial skill affects his/her opportunity for profit or loss; the nature and degree of the employer’s control over the worker; among other factors.

As an example, consider two home health care workers: Caregiver A and Caregiver B.

Caregiver A provides home health care to clients, performing assignments only as determined by the home health care agency he works for. He does not independently schedule assignments, solicit additional work from other clients, advertise his services or endeavor to reduce costs.

In this scenario, the worker does not exercise managerial skill that affects his profit or loss, according to the DOL guidance. This lack of managerial skill is indicative of an employment relationship between the worker and the home health care company.

In contrast, Caregiver B provides home health care to clients, but does produce advertising, negotiates contracts, decides which jobs to perform and when to perform them, and recruits new clients. In this scenario, the worker exercises managerial skill that affects his opportunity for profit and loss, which is indicative of an independent contractor.

It is important to note that both of these scenarios fall under just one of the six guiding factors, all of which the DOL says “should not be analyzed mechanically or in a vacuum, and no single factor, including control, should be over-emphasized.”

Instead, the DOL requires that each factor should be considered in light of the ultimate determination of whether the worker is really in business for himself or herself, and thus is an independent contractor, or is economically dependent on the employer, and thus is an employee.

“These factors should be used as guides to answer the ultimate question of economic dependence,” Weil states in the guidance.

View the DOL guidance.

Written by Jason Oliva

The post Feds Issue Contract Worker Guidance for Home Care, Other Industries appeared first on Home Health Care News.

The report, released this week in conjunction with the Massachusetts Institute of Technology (MIT) AgeLab, finds that Hawaii is the state where older Americans have the highest well-being, while West Virginia ranked as the state with the lowest well-being for adults age 55 and older.

The rankings are based on data from the Gallup-Healthways Well-Being Index, described as a definitive measure and empiric database of real-time changes in well-being throughout the world. Gallup, known for its public opinion polls, is a research-based, global performance-management consulting company. Healthways employs experts in research, analytics and medical science to work with clients across a range of health-related fields.

Specifically, the report is based on self-reported data gleaned from 114,388 interviews with individuals age 55 and older, focusing on five elements of well-being: purpose, social, financial, community and physical. These five elements, according to Gallup and Healthways, create a composite picture of the well-being of older Americans in each state.

Taking that criteria into consideration, the top 10 states with the highest well-being for older Americans are Hawaii, Montana, South Dakota, Alaska, Iowa, New Hampshire, Utah, Oregon, New Mexico and Connecticut.

The Aloha State ranked highest in both the Community and Physical categories, while Purpose (2) and Financial (7) also placed within the top 10. The state earned its lowest rank (20) in the Social category.

Nationally, the research revealed that adults age 55 and older have higher well-being than the rest of the population across all five elements, and that well-being improves with age. For example, people 75 and older have even higher well-being than those ages 65 to 74.

Older adults were also found to enjoy high rates of financial well-being, where 52% are thriving, compared to 32% of Americans younger than 55.

This trajectory of well-being is noteworthy as researchers see a decline in well-being when people reach their late forties and early fifties, but then a “significant increase” across all five elements after that, said Dan Witters, research director of the Gallup-Healthways Well-Being Index.

“From previous research, we know that higher well-being correlates with lower healthcare costs and increased productivity,” Witters said in a written statement. “Maintaining high well-being for older Americans will be especially important to employers as our country’s workforce ages and more individuals delay retirement.”

As for the states with the lowest well-being, the bottom 10 was anchored by West Virginia, which was preceded by Kentucky, Oklahoma, Ohio, Indiana, Nevada, Alabama, Tennessee, Mississippi and Louisiana.

See where your state ranked.

Written by Jason Oliva

The post Top 10 States for Seniors’ Well-Being appeared first on Home Health Care News.

Just 32% of Americans age 40 and older say they are “very” or “extremely” confident they will have the financial resources to pay for ongoing living assistance, according to the latest Long-Term Care Poll conducted by the Associated Press-NORC Center for Public Affairs Research. Conversely, 35% are “somewhat confident,” while 30% are are “not very” or “not at all” confident.

These findings are consistent with previous years’ reports from the AP-NORC Center which, with funding from The SCAN Foundation, conducted 1,735 phone interviews with a national sample of Americans age 40 and older for the 2015 survey.

Confidence, however, seemed to get better with age, as older respondents felt more financially prepared to tackle these costs than their younger counterparts. For example, adults age 40-54 (26%) and 55-64 (33%) had lower levels of confidence in their financial preparedness than adults age 65 or older (40%).

Personal health and household incomes fed into Americans’ confidence levels, with those rating their personal health as “excellent” or “very good” having greater faith in their ability to pay for long-term care than those who rated their health as “good,” “fair,” or “poor” (41% vs. 29% vs. 22%).

Meanwhile, adults with household incomes greater than $50,000 were more likely than those with incomes of less than $50,000 to say they are confident in their financial preparedness for long-term care (40% vs. 24%).

Planning lags

Although a majority of Americans expect they will need long-term care later in life, most are doing little to no planning when it comes to saving for this critical life phase.

Two-thirds of Americans age 40 and older reported doing little to no planning for their own care needs (67%) in 2014, compared to just over half reporting this in 2015 (54%).

Conversely, 21% of Americans in 2015 report doing a “great deal”or “quite a bit” of planning, compared to just 13% who reported the same last year.

Breaking down responses by age, older adults are more likely to report taking many of these planning actions. And the likelihood of planning for aging varies greatly by household income.

Those age 40 and older with a household income of $50,000 or greater were more than twice as likely as those who earn less to set aside money to pay for their own care (45% vs. 19%).

This demographic was also more likely to take other actions such as looking for information about long-term care insurance, creating an advanced directive or living will, and discussing funeral plans.

A growing likelihood

In 2000, Americans age 65 or older made up only 12% of the national population; however, seniors are projected to comprise about 22% by 2040, according to statistics cited by the AP-NORC Center.

“With this expanding need comes a demand for ways to maintain high-quality services and to make financing such care manageable for families and governments alike,” the report states.

But over the past two years, there has been a steady decline in the number of adults age 40 and older who believe in the likelihood that they will need long-term care when they age.

In 2015, slightly more than half (53%) of these Americans say it is at least “somewhat likely” they will need ongoing assistance one day, including the 19% of adults who believe it is “very” or “extremely” likely.

The percentage of adults age 40 and older who reported this is “somewhat likely” was 60% in 2014. In 2013, this proportion was 65%.

There are a number of potential reasons for this decline in expectations about the need for care.

“One potential explanation is a general increase in optimism and future outlook due to improvements in the economy since this poll started in 2013,” the report states. “This improved outlook could lead people to feel more optimistic about their own long-term health situation.”

Another potential reason, the AP-NORC Center notes, could be due to a slow generational shift in the group of Americans who are age 40 and older for each of these polls, including fewer Baby Boomers and more Gen-Xers.

“If the younger groups have parents who are living progressively longer, this could impact how they anticipate their own needs for future care,” the report states. “These hypotheses are speculations that we cannot substantiate with data from this survey.”

Written by Jason Oliva

The post Americans Underestimate Senior Care Needs, Slack on Planning appeared first on Home Health Care News.

The new agency aims to provide a comprehensive continuum of care after patients have been discharged from the hospital in efforts to facilitate efficient communication, safety and quicker recovery. 

With a staff of 17,000, AccentCare’s services range from personal, non-medical care to skilled nursing, rehabilitation, hospice and care management. 

Under the agreement, UC San Diego Health System will be responsible for the clinical oversight of post-acute services provided by the new joint agency. AccentCare will provide day-to-day operational management, including patient intake, staffing, home health services such as physical therapy, medical social work and skilled nursing. 

The formation of the new agency aligns with the shared strategic visions between the companies to develop new approaches to manage and deliver high-quality care across the health care continuum.

“UC San Diego Health System is committed to improving patient care, clinical quality and overall patient experience, even after a patient leaves one of our hospitals,” said Paul Viviano, CEO of UC San Diego Health System, in a written statement. “In collaboration with AccentCare, protocols and processes will be established that focus on early interventions to prevent falls, infections and medication errors in the home.”

As a result of the joint venture, the new agency will enhance UC’s ability to more efficiently manage inpatient capacity and flow, as well as provide patients with post-acute services that link their UC San Diego Health System physicians for optimal clinical oversight. 

The partnership with AccentCare will also positions the health system to better serve diverse populations of patients with chronic diseases while responding to changing reimbursement methodologies.  

For AccentCare, the joint venture will further extend its reach in California, and is similar to partnerships the company has formed, or is pursuing, within its 10 states of operation. Currently the company’s reach exceeds more than 110 locations in Arizona, California, Colorado, Georgia, New York, Ohio, Oregon, Tennessee, Texas and Washington.

“This is a valuable partnership for AccentCare and UC San Diego Health System that directly benefits patients,” said Steve Rodgers, CEO of AccentCare, in a prepared statement. “The agency will extend UC San Diego Health System’s services and expand AccentCare’s community reach with the overall goal of achieving comprehensive care and exceptional health outcomes.”

Written by Jason Oliva

The post AccentCare, UC San Diego Form Joint Venture Home Health Company appeared first on Home Health Care News.

Amedisys, Inc. (Nasdaq: AMED), LHC Group (Nasdaq: LHC) and Almost Family, Inc. (Nasdaq: AFAM) are leading the pack for growth, according to the most recent Home Health Index (HHI) from Stoneridge Partners, a merger and acquisition firm that provides intermediary services to home care, hospice and behavioral health agencies.

Following a 3.3% gain in May, Stoneridge’s HHI surged another 11% in June, bringing the year-to-date increase to over 30%. On a year-over-year basis, the Index is now up 95%.

“Our HH Index has not been at this level since May of 2010, and we are now closing in on our all time high of 41.75 set in September 2008,” Stoneridge notes in a July 1st update.

Each of the publicly-traded home health companies has seen their stock prices grow over the past month, as well as the past year, according to Stonebridge’s analysis.

While Almost Family and LHC Group were up about 4% in June, it was Amedisys that commanded the largest increase with over a 28% gain during the month. The company’s $39.73 stock price at the end of June represents a 137.34% increase when compared to what it was a year ago.

Meanwhile, Almost Family and LHC recorded one-year growths of 80.75% and 78.99%, respectively.

The growth among these top three firms is particularly impressive, Stonebridge notes, especially when compared to the market as a whole—the S&P 500 now flat for the year, and up only 5% from one year ago.

Written by Jason Oliva

The post Wall Street Stays Amped on Big 3 Home Health Companies appeared first on Home Health Care News.